中国病案
中國病案
중국병안
Chinese Medical Record
2015年
9期
33-34
,共2页
国际疾病分类%疾病诊断%相似%实例
國際疾病分類%疾病診斷%相似%實例
국제질병분류%질병진단%상사%실례
International disease classification%Diseases diagnosis%Analysis%Cases
通过对日常工作中遇到的某些诊断名称相似的疾病进行ICD-10编码分析后，总结出疾病诊断的细微差别对ICD-10编码影响较大。某些诊断仅一字之差，或仅多一修饰词，疾病性质就发生了改变，即由普通妇科疾病转变为妇科肿瘤，或由良性肿瘤转变为恶性肿瘤，导致其ICD-10编码完全不同。某些相似的诊断即使疾病性质相同但不属于同种疾病，ICD-10编码也不相同。欲提高对此类情况分类的准确性，编码员需具备扎实的医学基础、良好的工作习惯和较高的编码水平，只有这样才能确保疾病分类工作的准确性，以便更好地为医、教、研服务。
通過對日常工作中遇到的某些診斷名稱相似的疾病進行ICD-10編碼分析後，總結齣疾病診斷的細微差彆對ICD-10編碼影響較大。某些診斷僅一字之差，或僅多一脩飾詞，疾病性質就髮生瞭改變，即由普通婦科疾病轉變為婦科腫瘤，或由良性腫瘤轉變為噁性腫瘤，導緻其ICD-10編碼完全不同。某些相似的診斷即使疾病性質相同但不屬于同種疾病，ICD-10編碼也不相同。欲提高對此類情況分類的準確性，編碼員需具備扎實的醫學基礎、良好的工作習慣和較高的編碼水平，隻有這樣纔能確保疾病分類工作的準確性，以便更好地為醫、教、研服務。
통과대일상공작중우도적모사진단명칭상사적질병진행ICD-10편마분석후，총결출질병진단적세미차별대ICD-10편마영향교대。모사진단부일자지차，혹부다일수식사，질병성질취발생료개변，즉유보통부과질병전변위부과종류，혹유량성종류전변위악성종류，도치기ICD-10편마완전불동。모사상사적진단즉사질병성질상동단불속우동충질병，ICD-10편마야불상동。욕제고대차류정황분류적준학성，편마원수구비찰실적의학기출、량호적공작습관화교고적편마수평，지유저양재능학보질병분류공작적준학성，이편경호지위의、교、연복무。
Through conducting ICD-10 coding analysis on diseases with similar diagnosis names in our daily work, we concluded that little difference could make big effect on the ICD-10 coding of the diseases. The character of the diseases could be changed by only a different word or qualifier. For example, the common gynecological disease could change into tumor, or transfer into cancer from benign tumor, which resulted in the absolute difference in ICD-10 coding. And also the ICD-10 coding of some similar diseases was different although they had same characters but with different homogeneity. In order to improve the accuracy of such situations, the coders should have concrete basis of medical knowledge, good work habit and better coding skill, only by this way could guarantee the accuracy of the diseases classification work as well as provide service for the three aspects included medicine, teaching and research.
